Provider Demographics
NPI:1396736385
Name:STEWART, DEANNA (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAWKINS STORE RD
Mailing Address - Street 2:SUITE B 1
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:770-928-0862
Mailing Address - Fax:770-928-2286
Practice Address - Street 1:205 HAWKINS STORE RD
Practice Address - Street 2:SUITE B 1
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-928-0862
Practice Address - Fax:770-928-2286
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012876208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics